Clinical management of
antidepressant discontinuation

by
Rosenbaum JF, Zajecka J
Clinical Psychopharmacology Unit,
Massachusetts General Hospital,
Boston 02114, USA.
J Clin Psychiatry 1997; 58 Suppl 7:37-40


ABSTRACT

To minimize the symptoms of antidepressant discontinuation, gradual tapering is necessary for all serotonin reuptake inhibitors (SRIs) except fluoxetine, which has an extended half-life. Agents with shorter half-lives such as venlafaxine, fluvoxamine, and paroxetine should be tapered gradually. Discontinuation symptoms, which frequently emerge after abrupt discontinuation or intermittent non-compliance and, less frequently, during dose reduction, are generally mild, short-lived, and self-limiting but can be distressing and may lead to missed work days and decreased productivity. The symptoms may be somatic (e.g., dizziness and light-headedness; nausea and vomiting; fatigue, lethargy, myalgia, chills, and other flu-like symptoms; sensory and sleep disturbances) or psychological (anxiety and/or agitation, crying spells, irritability). Mild symptoms can often be treated by simply reassuring the patient that they are usually transient, but for more severe symptoms, it may be necessary to reinstitute the dosage of the original antidepressant and slow the rate of taper. Symptoms of discontinuation may be mistaken for physical illness or relapse into depression; misdiagnosing the symptoms may lead to unnecessary, costly tests and treatment. Thus, health care professionals need to be educated about the potential adverse effects of SRI discontinuation.
SSRIs
Serotonin
Sertraline
Citalopram
Fluoxetine
Paroxetine
Venlafaxine
Fluvoxamine
SSRI toxicology
SSRI pharmacology
The serotonin syndrome
SSRI discontinuation syndrome
Antidepressant addiction potential
Antidepressant discontinuation-related mania
Paroxetine (Paxil, Seroxat), pain and the opioid system


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